Acta orthopaedica Scandinavica最新文献

{"title":"Neutrophils are active in total joint implant loosening.","authors":"Waldemar Wozniak,&nbsp;Jacek Markuszewski,&nbsp;Malgorzata Wierusz-Kozlowska,&nbsp;Henryk Wysocki","doi":"10.1080/00016470410001402","DOIUrl":"https://doi.org/10.1080/00016470410001402","url":null,"abstract":"<p><strong>Background: </strong>Polymorphonuclear neutrophils (PMN) are the first cells to take part in the local foreign body reaction in aseptic loosening of endoprostheses. The aim of this study was to evaluate the systemic host reaction to total joint replacement by measuring the production of nitric oxide by neutrophils before and after total joint replacement.</p><p><strong>Patients and method: </strong>Blood samples were collected from 33 patients (27 hips and 6 knees) before surgery, and 2 weeks, 2 months and 2.5-3 years after surgery. The levels of nitric oxide produced by PMN were measured by the method described by Markert et al. (1994).</p><p><strong>Results: </strong>Patients reporting pain in the region of the implant 3 years after surgery, and also patients with radiographic signs of loosening, had higher production of NO in the early period and 3 years after the implantation than those with good clinical results.</p><p><strong>Interpretation: </strong>We propose that elevated levels of nitric oxide production by PMNs may serve as a marker of total joint prosthesis loosening.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 5","pages":"549-53"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24786664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigation in total-knee arthroplasty: CT-based implantation compared with the conventional technique.","authors":"Lars Perlick,&nbsp;Holger Bäthis,&nbsp;Markus Tingart,&nbsp;Carsten Perlick,&nbsp;Joachim Grifka","doi":"10.1080/00016470410001259-1","DOIUrl":"https://doi.org/10.1080/00016470410001259-1","url":null,"abstract":"<p><p>Background Exact axial limb alignment in total-knee arthroplasty (TKA) is important for a successful outcome. We evaluated the efficiency of computer-assisted implantation in TKA and compared it with the classical surgeon-controlled technique. Patients and methods We implanted 100 TKA using either the computer-assisted technique (50) or the conventional approach (50). There were no significant differences between the groups regarding the preoperative leg deformity. Accuracy of implantation was determined in postoperative long-leg coronal and lateral radiographs. Results A postoperative leg axis between 3 degrees varus and 3 degrees valgus was achieved in 46 patients in the group with computer-assisted implantation and 36 patients in the control group (p=0.01). A significant difference was also seen for the femoral component alignment in frontal plane. No complications influencing the clinical outcome were observed. Interpretation A CT-based navigation system improves the accuracy of TKA, but higher costs and time-consuming planning will mean that its usage is limited to special cases. Additional tools such as ligament balancing, which are presently only available with the CT-free software module, require to be added to the CT-based system.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"464-70"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001259-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual strength testing in 14 upper limb muscles: a study of inter-rater reliability.","authors":"Jørgen Jepsen,&nbsp;Lise Laursen,&nbsp;Anders Larsen,&nbsp;Carl-Göran Hagert","doi":"10.1080/00016470410001222-1","DOIUrl":"https://doi.org/10.1080/00016470410001222-1","url":null,"abstract":"<p><strong>Background: </strong>Manual muscle testing has been termed a \"lost art\" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles.</p><p><strong>Patients and methods: </strong>The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classified 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specific for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classified as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by kappa-statistics. In addition, the odds ratio for the relation to symptoms of the definition in agreement of strength was calculated.</p><p><strong>Results: </strong>The median kappa-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was significantly associated with the presence of symptoms.</p><p><strong>Interpretation: </strong>This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"442-8"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001222-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined radiology and cytology in the diagnosis of bone lesions: a retrospective study of 370 cases.","authors":"Veli Söderlund,&nbsp;Lambert Skoog,&nbsp;Andris Kreicbergs","doi":"10.1080/00016470410001303-1","DOIUrl":"https://doi.org/10.1080/00016470410001303-1","url":null,"abstract":"<p><strong>Background: </strong>Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied.</p><p><strong>Results: </strong>Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%.</p><p><strong>Interpretation: </strong>Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"492-9"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001303-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of chronic entrapment of the ring finger flexor profundus muscle in ulnar shaft fractures in children--a case report.","authors":"David Hendel","doi":"10.1080/00016470410001321-1","DOIUrl":"https://doi.org/10.1080/00016470410001321-1","url":null,"abstract":"Two children with a passive extension lag of the ring fi nger following forearm fracture have been treated in our clinic during the last 10 years, one with acute entrapment and the second with chronic entrapment. We have also treated 8 children with imminent entrapment. A description of the acute case was published in 1992 (Hendel and Aner 1992). The chronic case involved a previously healthy 16-year-old boy who presented with passive extension lag of the ring fi nger. The lag was more remarkable in the ring fi nger, but was also noticeable to a lesser extent in the little and middle fi ngers. The lag was more pronounced when the wrist was placed in extension and neutral position and less obvious when fl exed (Figure). 9 years previously, the boy had had a forearm fracture which was treated by closed reduction and plaster. A ring fi nger extension lag gradually developed a few weeks after plaster removal. Plain radiographs revealed healed fractures of the radius and ulna. Exploration of the origin of the fl exor muscles was performed, reaching the proximal ulna through a volar approach. The FDP of the ring fi nger was seen to be adherent to fi tissue around the ulna at the junction of the muscle belly and the tendon. The entrapped muscle was carefully released from the ulna. Full range of motion of the digits was achieved immediately. After surgery, the patient wore a volar splint for 1 month, with the wrist in neutral position and the fi ngers fully extended, and underwent physical therapy. At the last follow-up, 2 years after surgery, the patient had full active and passive range of motion of the digits. Following the chronic case of entrapment, we started to follow all our cases of forearm fracture during plaster treatment and after plaster removal, by performing a passive stretch test","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"503-4"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001321-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive effects of short-term growth hormone treatment on lean body mass and BMC after a hip fracture: a double-blind placebo-controlled pilot study in 20 patients.","authors":"Margareta Hedström,&nbsp;Maria Sääf,&nbsp;Eva Brosjö,&nbsp;Carolin Hurtig,&nbsp;Kerstin Sjöberg,&nbsp;Ann Wesslau,&nbsp;Nils Dalén","doi":"10.1080/00016470410001141-1","DOIUrl":"https://doi.org/10.1080/00016470410001141-1","url":null,"abstract":"<p><strong>Background: </strong>A catabolic state develops after a hip fracture, with loss of muscle and bone tissue. Growth hormone (GH) treatment has been shown to exert anabolic effects during other catabolic states. We investigated whether GH given postoperatively to elderly hip fracture patients could increase serum insulin-like growth factor-I (IGF-I) and reduce the loss of lean body mass and bone mineral content (BMC) without considerable side effects.</p><p><strong>Patients and methods: </strong>We randomized 20 patients operated on for a hip fracture to a double-blind placebo-controlled 4-week study with daily subcutaneous injections of GH or placebo. The patients were followed for another 2 months after termination of GH treatment.</p><p><strong>Results: </strong>Serum IGF-I and the IGF-I binding protein 1 (IGFBP-1) were measured by specific radioimmunoassay (RIA) technique. BMC and lean body mass were assessed by dual-energy X-ray absorptiometry and quantitative computed tomography. Serum IGF-I increased significantly during GH treatment, which also preserved lean body mass and BMC without serious adverse events.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"394-401"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001141-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Registration in the danish hip arthroplasty registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications.","authors":"Alma Pedersen,&nbsp;Søren Johnsen,&nbsp;Søren Overgaard,&nbsp;Kjeld Søballe,&nbsp;Henrik T Sørensen,&nbsp;Ulf Lucht","doi":"10.1080/00016470410001213-1","DOIUrl":"https://doi.org/10.1080/00016470410001213-1","url":null,"abstract":"<p><strong>Background: </strong>There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark.</p><p><strong>Patients and methods: </strong>We assessed the completeness of registration of primary total hip arthroplasties (THAs) and revisions in the DHR from 1995-2000. In addition, the positive predictive value (PPV) of registered data for diagnoses in patients undergoing primary THA and postoperative complications was analyzed. Completeness was assessed using the Danish National Registry of Patients (NRP) as a reference, which is a nationwide and population-based registry of all somatic hospital admissions since 1977. The positive predictive value of registered data was assessed by review of medical records and preoperative radiographs from samples of randomly selected patients registered in the DHR using a standardized form.</p><p><strong>Results: </strong>The overall completeness of registration for primary THAs and/or revisions was 94% (26,129 patients registered in both NRP and DHR and 27,757 patients registered in the NRP). There was a lower degree of completeness for revisions than for primary THAs (81% versus 94%). The completeness did not vary substantially according to gender and age. Completeness of registration was lower for university hospitals than for other hospitals (91% versus 95%), and for low-volume hospitals (87%) relative to those with medium (92%) and high volumes (96%). Overall, the diagnoses in patients undergoing primary THA could be confirmed in 84% (387/459) of the patients who were reviewed. The diagnosis of fresh fracture of the proximal femur was confirmed in only one third (22/73) of the cases. Postoperative complications were confirmed in two-thirds (36/54) of the patients reviewed. The specificity of the registration of postoperative complications was, however, only one-third (8/26).</p><p><strong>Interpretation: </strong>We conclude that the Danish Hip Arthroplasty Registry is a potentially valuable tool for quality improvement and research due to the high degree of completeness of registrations regarding THA, and its moderate-to-high positive predictive value of registration for diagnoses in patients undergoing primary THA. However, information on several diagnoses for primary THA and on postoperative complications should be used with caution.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"434-41"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001213-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early revision after hemiarthroplasty and osteosynthesis of cervical hip fracture: short-term function mortality unchanged in 102 patients.","authors":"Jaakko Sipilä,&nbsp;Pekka Hyvönen,&nbsp;Juha Partanen,&nbsp;Jukka Ristiniemi,&nbsp;Pekka Jalovaara","doi":"10.1080/00016470410001150-1","DOIUrl":"https://doi.org/10.1080/00016470410001150-1","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on whether osteosynthesis or hemiarthroplasty is preferable in the treatment of cervical hip fractures. Osteosynthesis is associated with more reoperations than hemiarthroplasty but there is little information available on the consequences of these reoperations.</p><p><strong>Patients and methods: </strong>We studied the effect on mortality, hospital stay and functional outcome of revision performed within 4 months of primary surgery with hemiarthroplasty or osteosynthesis for cervical hip fracture. 50 (6%) of 792 patients treated with uncemented Austin-Moore hemiarthroplasty and 52 (13%) of 411 patients with osteosynthesis (86 with two hook pins and 325 with three cannulated screws) had had revision surgery. Control groups matched for age, sex, residential status, walking ability at fracture, type of primary operation and fracture type consisted of patients who had not had a reoperation.</p><p><strong>Results: </strong>Reoperation impaired walking ability and was associated with increased use of walking aids at 4 months in the hemiarthroplasty group and the osteosynthesis group as compared to controls, but did not have any statistically significant effect on residential status. In the hemiarthroplasty group, 4-month mortality was 12% among the reoperated patients and 18% among the controls, while mortality at 1 year was 24% in both groups. The corresponding figures in the osteosynthesis group and controls were 6% and 6% at 4 months, respectively, and 17% and 13% at 1 year.</p><p><strong>Interpretation: </strong>To some extent, reoperation impairs early functional outcome after cervical hip fracture treated by either osteosynthesis or hemiarthroplasty, but does not increase mortality to any significant degree.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"402-7"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001150-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of head and neck geometry on stability of total hip replacement: a mechanical test study.","authors":"Rainer Bader,&nbsp;Roger Scholz,&nbsp;Erwin Steinhauser,&nbsp;Susanne Zimmermann,&nbsp;Raymonde Busch,&nbsp;Wolfram Mittelmeier","doi":"10.1080/00016470410001178-1","DOIUrl":"https://doi.org/10.1080/00016470410001178-1","url":null,"abstract":"<p><strong>Background: </strong>Dislocation after replacement may be caused by poor implant design or positioning, or by the surgical approach taken. We evaluated the influence of head and neck design on range of motion and stability (with respect to risk of dislocation) in total hip endoprostheses.</p><p><strong>Material and methods: </strong>Using a test device, we determined the stability afforded by different head sizes and neck geometries for various implant positions.</p><p><strong>Results: </strong>Increasing head diameter led to an enhancement of range of motion as well as resistance against subluxation, and thus to improved stability in any movement combination and implant orientation. Smaller femoral heads were associated with increased risk of dislocation, especially in a poor implant position such as retroversion, and steep positioning of the cup. Skirted metal or mushroom-shaped ceramic heads had a reduced range of motion until impingement of approx. 20 degrees, as compared to spherical standard heads. Furthermore, after identical joint loading, skirted heads dislocated more readily than standard heads with corresponding diameters.</p><p><strong>Interpretation: </strong>To obtain sufficient joint mobility and stability, neck geometry and implant position should be considered when choosing the femoral head size.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"415-21"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001178-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Movement pattern of the Exeter femoral stem; a radiostereometric analysis of 22 primary hip arthroplasties followed for 5 years..","authors":"Anna Stefánsdóttir,&nbsp;Herbert Franzén,&nbsp;Ragnar Johnsson,&nbsp;Ewald Ornstein,&nbsp;Martin Sundberg","doi":"10.1080/00016470410001169-1","DOIUrl":"https://doi.org/10.1080/00016470410001169-1","url":null,"abstract":"<p><strong>Background: </strong>The design of the Exeter stem may facilitate distal migration, but radiostereometric analysis (RSA) studies have been limited to 2 years of follow-up.</p><p><strong>Patients and methods: </strong>We followed migration of the Exeter femoral stems in 22 primary hip arthroplasties for 5 years with RSA.</p><p><strong>Results: </strong>All stems migrated distally and the median migration at 2 years was 1.34 mm, while at 5 years it was 1.77 mm. 7 stems migrated above accuracy between 3 and 5 years. (RSA) evaluation of the cement mantle could be performed in 14 cases, and in 5 slight migration was found. Most of the stems rotated towards retroversion and the median rotation at 2 years was 1.2 degrees, while at 5 years it was 1.6 degrees. We found 1 patient with impending clinical failure but no deviation in the RSA migration pattern, and 1 patient with unstable migration pattern but no clinical symptoms.</p><p><strong>Interpretation: </strong>We found a greater distal migration of the Exeter stem for longer periods of time than seen with other types of cemented implants.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"408-14"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001169-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}